How is the Placenta Delivered?
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Kaely Harrod 0:00
Hi. Welcome back to Kaely daily. Today's question is how is a placenta delivered? This is Kaely daily, the bi weekly podcast about all things doula Tips and Tips where we answer one question about pregnancy, labor, postpartum, or lactation, in order to have your journey in this parenting world be just a little bit more informed and filled with consent. Hello, and welcome back. I am Kaely Harrod, your host of Kaely Daily, doula Tips and Tits with all sorts of questions and answers about pregnancy, birth, postpartum and lactation. Today is another episode about placentas. So the question today is how are placentas delivered. And there are a few answers to this. So I'm going to start with vaginal delivery, and then talk about cesarean just a tiny bit. So in vaginal delivery, there are two typical manners in which a placenta is delivered. One is called active management and the other is called expectant waiting. Now, in my experience, active management is more commonly used in a hospital setting, almost all hospital births, have active management. And then expectant waiting is more of a scenario in out of hospital birth. Although I have seen it in hospital birth. It has been primarily when a client of mine has specifically requested it, and not been the default of the providers that in the hospital setting for a variety of reasons, which I that's not what this episode is about. So I want to explain the differences between the two. So active management is where usually Pitocin so that's the medication that's the synthetic form of oxytocin. So that is administered either through the IV or in an intramuscular injection, so typically given in the thigh, and that is administered immediately after birth, along with fundal massage. Now, what fundal massage is, is let's say your uterus is like coming down, it wouldn't be the size of a fist yet, the funnel massage is pushing into your abdomen and feeling the top of the uterus. So it's pretty firm massage into your abdomen, and then we're like rubbing the top of the uterus. So that's called funnel massage. And then the third piece of it is traction on the chord externally. Now traction on the cord externally means gentle tugging on the external cord to help the release of the placenta. Now, there are some risks associated with this. One is that tugging specifically can sever the cord if it's done too aggressively. It can also sever the cord if if you have a marginal cord insertion, meaning that your cord inserts to the very edge of your placenta. And it can cause a partial separation where part of the placenta has detached but the other part has not. And it can cause an inverted uterus. If the tugging is too firm and the uterus. It will not the placenta won't detach from the wall of the uterus. So I have seen all three of those complications. So as a doula I educate about this a lot. Because I've I've seen them happen, right. And so it's, it's important to me that people know their options and the risks and benefits around it. Now, Pitocin itself has been proven to do a lot in terms of mitigate postpartum hemorrhage. So some hospital providers will do the Pitocin and the fundal massage without the traction on the cord. Or they'll only do traction on the cord when they already see that the placenta has detached and is just inside the vaginal canal waiting to be pulled out. Okay, so then there's it's not really traction as much as it's just helping ease it out of the out of the vagina.
Kaely Harrod 4:20
Now expectant waiting is just what it sounds like you You're literally just waiting expectantly for the placenta to be born. But I think it's helpful to know that it's not that that expectant waiting is is passive, right? Because still in an expectant waiting situation, that the provider is watching for excessive bleeding, they have the tools needed to mitigate that right. They have the ability to do like Pitocin and fondle massage and traction on the court and all of that if it's necessary, but if it is not necessary, then it's avoided. Okay, so those are the two mean wait. Now. That's that's if a normal delivery occurs. This is not the question for today. But I will add this question that how quickly after birth to the placenta be delivered. And I'll say it's anywhere from in the moment of birth when a baby's born like still in their amniotic sac, to, to up to two hours later. Now, most hospitals really want a placenta to be out by about 30 minutes. So again, that patients have waiting two hours is usually in an out of hospital situation. And even that is not all that common. Many placentas are born within 20 or 30 minutes are delivered within 2030 minutes of the baby being born. And so in most cases, you don't have a two hour delay like that. But hospitals tend to get a little antsy around half an hour. So in an in a complicated placenta delivery, so let's say placenta is retained, okay, where placenta isn't, isn't coming out well, or isn't being delivered at all, then something called a manual removal is done if you are having a vaginal delivery, and that is where the provider literally removes the placenta with their arm, like inside of your body, which is not particularly pleasant. That is does not happen all that often. When it does happen, you run the risk of some placental retention and some placental products being left over. So oftentimes, they'll ask that you come back for an ultrasound just to be sure that the entire placenta was removed in a situation of manual removal. Now, if you have a C section, the placenta is removed as a part of the C section itself. So it's not something that you deliver later, you don't have to do the work of like pushing or traction or any of that. It is all part of the process of the Cesarean section. Okay. So that is today's information. We have a few more episodes on placentas at least planned. So you should hear a few more things about placentas, including a chat with a friend of mine who is a placenta encapsulation specialist. And I just want to remind you that this information is always for information and education and entertainment, not medical advice, because I am not your medical provider. And also my my desire in these episodes is to leave you just a little bit more informed so that you can have educated consent filled births, and therefore have a more satisfying experience, both in birth but also in postpartum. And so I would love to hear from you. I would love to hear what questions you have, so that I can answer your questions directly. Instagram is the easiest way to do that. So hop on over there send me a message let me know what questions you have. Or subscribe, leave a review, leave a comment here on whatever platform you're watching this on subscribing, like if you're on YouTube, and then communicate with me that way so that I can see what will be helpful to you what information you'd like to hear about in these episodes. So until the next episode, I wish you wonderfully educated consent filled births by added and produced by Kaely Herat as I'm sure you can probably tell, and our amazing music is credited in the shownotes as well. So we look forward to seeing you on the next episode. And in the meantime, have a wonderful and consent filled
Unknown Speaker 8:54
birth.
Transcribed by https://otter.ai
There are two main ways placentas are routinely delivered during a vaginal delivery. Active Management and Expectant Waiting. This episode goes into the what, how, when and why of those two forms of management and gives you context for them both.
KEY TAKEAWAYS
Active Management is often used in hospital birth settings
Expectant Waiting is more common in out of hospital birth settings (home and birth center)
There are a variety of hybrids between these two methods that are deployed regularly as well.
RESOURCES
FREE OXYTOCIN GUIDE:
6 Ways to Increase Oxytocin for Labor Progression
https://www.harroddoulaservices.com/free-guide-6-oxytocin-tips
CONNECT with Kaely on Instagram
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Kaely Daily is produced by Kaely Harrod of Harrod Doula Services
It is sponsored by The Birth Prep Blueprint Childbirth Class
Music by Madirfan: Hidden Place on Pixabay
